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Whether you decide to have reconstruction or not,
if you're facing a mastectomy (either to treat or prevent breast cancer), you'll likely do much better and feel more
in control if you know what to expect and how to prepare.
Why is mastectomy recommended for some women and not
for others? Treatment is defined by how far the cancer has spread, the size of the tumor, and a woman's risk of recurrence.
If the tumor is less than 4cm, appears only in one quadrant of the breast, and can be removed with clear margins, you
can be treated with lumpectomy with radiation or mastectomy.
Mastectomy will be the recommended treatment if your
breast cancer is larger than 4cm, appears in more than one quadrant of your breast, or has advanced beyond the breast. Other
factors, and your own personal preferences, may also influence whether you have mastectomy.
If you decide
to have immediate reconstruction, your breast surgeon will perform a skin-sparing mastectomy; he will remove as much breast
tissue as possible, while leaving your breast skin intact. Once this is completed, and while you are still under
anesthesia, the reconstructive surgeon then replaces your breast tissue with a temporary expandable implant, a full-sized
implant, or your own tissue, depending on the reconstructive technique you have chosen.
For many women, a nipple-sparing
mastectomy can also be done. This procedure preserves your own nipple, although it may not have the same sensation it did
prior to mastectomy. Nipple-sparing mastectomy is not appropriate for women who have tumors in or near the nipple or in the
skin surrounding the nipple.
Some of the effects of mastectomy are permanent, whether you have reconstruction or
not. Removing breast tissue eliminates the ducts that produce milk, so after mastectomy you will be unable to breastfeed.
Also, the breast and surrounding area remain numb; the amount of sensation that returns varies, but generally, most women
do not have much sensation, even in the reconstructed breast.
If you don't have reconstruction at
the time of your mastectomy, your breasts can be recreated later. Cosmetically, immediate reconstruction produces less visible
scarring. Delayed reconstruction, however, can still provide excellent results, although the mastectomy scar will always
appear across the new breast. Scars do fade considerable with time. Considering Prophylactic Mastectomy Prophylactic mastectomy removes an otherwise healthy
breast to reduce a woman's risk of breast cancer. It's a deeply personal act. It's also effective: remove most
of the breast tissue and you remove most of the risk.
If you're considering prophylactic mastectomy, remember
that your risk may be different than your sister's, your friend's or your neighbor's risk. Individual risk is
influenced by family history, individual medical history, and lifestyle.
As individuals, we have different risk
levels, and different tolerance for that risk. While one woman may consider a 35 percent risk tolerable, another might find
it completely unacceptable.
If you choose to have your breasts removed to reduce your risk of breast cancer, you
have options. If you decide to have your breasts rebuilt, your mastectomy can be performed in a manner advantageous to reconstruction.
Reconstruction following prophylactic mastectomy often rebuilds breasts with no visible scarring. There are many reconstructive
options to consider.
Here are a few things to consider about your risk of developing breast cancer:
- Know the difference between risk factors you can control,
and those you cannot. (A risk factor is something that increases your chance of developing a disease.)
- Act on the risk factors you can control.
Exercising and controlling your weight, for example, are known to lower risk, while drinking alcohol is believed to increase
risk.
- Hereditary breast cancers account
for only 5-10% of all breast cancer diagnosed.
- Most
women who develop breast cancer have no known risk factors for the disease.
- Having additional risk factors for breast cancer doesn't guarantee you'll develop the disease; it
means you're more likely to do so.
- Contact
a qualified genetic counselor to help determine your personal risk of developing breast cancer.
- Always consult with a genetic counselor before being tested for BRCA1 or
BRCA2 genetic gene mutations.
- Consider
alternatives for reducing your risk. If you're considered at high risk for breast cancer, talk to your physician about
semi-annual professional breast examinations, magnetic resonance imaging (MRI), or ductal lavage (a non-surgical breast biopsy).
You may also want to take Tamoxifen for its preventative effects or participate in a clinical trial.
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